Prognostic factors and treatment management of new onset diabetes after transplantation (NODAT)

AIM NODAT is a metabolic disease characterized by varying degrees of insulin resistance secondary to a range of pathologies after transplantation. Itsincidence is reported to be between 4% and 25%. There are modifiable, partially modifiable and non-modifiable factors that affect the development of NODAT. The aim of our study was to evaluate the incidence of NODAT in non-diabetic patients who underwent kidney transplantation and to investigate the predictable risk factors for the development of NODAT. METHOD A total of 72 patients undergoing kidney transplantation between November 2010 and October 2012 at Istanbul Bilim University Faculty of Medicine, Şişli Florence Nightingale Hospital were included in this study. Patients' age, gender, height, weight, body mass index, primary disease, history of dialysis, HLA tissue match, donors' age and gender, receivers hepatitis B and C status, thyroid hormones, lipid profiles, magnesium levels, systolic blood pressure, fasting and postprandial glucose plus HbA1c levels, postoperative insulin requirement, creatinine levels, immunosuppressive medications and their plasma levels, history of pulse steroid use, history of cellular or humoral rejection, history of CMV infection, history of pyelonephritis, use of antihypertensive medication and use of medication for NODAT were noted. Statistical analysis was performed on risk factors for development of NODAT. RESULTS Of the 72 patients included in this study, 33 were male (46%) and 39 were female (54%). NODAT developed in 17 patients (23.6%) and was not observed in 55 patients (76.4%). Univariate analysis showed that patients' age ? 45 years (p<0.0001), patients with BMI?30kg/m2 before transplantation or at 1st month post-transplantation (p=0.009, p=0.002), postoperative insulin requirement (p<0.0001), impaired fasting glucose levels at pre-transplant, 2nd, 4rd and 4th post-transplant weeks (p<0,0001, p=0,001,p=0,004, p<0,0001), impaired glucose tolerans before transplant (p=0.009)and tacrolimus plasma level of ? 10ng/dl (p=0.006) were statistically significant risk factors for the development of NODAT. Mutlivariate analysis showed that patients' age ? 45 years (p=0.01), pre-transplant impaired fasting glucose (p=0.001), post-transplant insulin requirement (p=0.01) and 1st postoperative month tacrolimus plasma levels (p=0.04) were found to be statistically significant independent risk factors for the development of NODAT. CONCLUSION Risk factors determined in this study show similarities with other studies in literature. The risk factors should be taken into account while following and treating such patients.